International Medical Health

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Mental Health Needs Present Challenge

West Sumatra Earthquake Relief

IDP Resettlements Underway

Amputees Still a Top Priority

2009 Annual Report Online

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Issue: #9 November 2009

Mental Health Needs Present Foreboding Challenge, amongst Other Concerns

The remaining Internally Displaced Persons (IDPs) who are currently residing in welfare camps in Vavuniya, are due to be resettled shortly under current government schemes, with many thousands already having been released. As of December 1, 2009 the IDPs were free to leave the camps temporarily for up to 15 days, after providing their details of how they can be reached. Of the total 40,000 families of Jaffna origin, the Government of Sri Lanka plans to resettle many in the coming months, with well over 65,000 persons already resettled in the area. However, it will take a massive undertaking by a number of committed parties to address the psychosocial well-being of the returnees. In light of this reality, IMHO is focusing its attention on addressing and improving the mental health of these persons who have endured the country's long-standing civil conflict and have had their lives uprooted. Returnees have gone through severe trauma and stress (PTSD), being caught in the middle of the violence as it peaked during the last stages of the war and many more years of hardship. The collapse of strong, binding structures like homes and income sources that provided livelihoods for generations, the witnessing of horrifying deaths of loved ones, sights of deceased bodies, going through the pangs of hunger and fear of death--all have been identified by local partners and government health officials as contributing to the deterioration of mental health. All of this brutalizes the personality and has far-reaching, long-term consequences. Personality disorders, such as poor impulse control, which lead to aggression and antisocial behavior, are common. Many people also carry overwhelming guilt in not being able to rescue their loved ones, provide them with a ritualistic burial, or properly care for them. Domestic violence also remains a concern, which has been very frequent in the IDP camps. While these mental health issues affect the entire population of displaced people, the risk is particularly acute for vulnerable groups such as the elderly, single mothers, families with children, and torture victims, all of whom would benefit greatly from a higher level of intervention. As one local professor in psychiatry so aptly put it, "Collective trauma manifesting as mistrust, dependency on relief, passivity and lack of motivation has come to stay. If the Tamil peoples are to recover and participate in any future reconciliation, reconstruction and development, they will have to be given not only appropriate psychosocial care but also economic opportunities to re-establish in life." Recognizing this reality, IMHO is working on a comprehensive psychosocial rehabilitation project targeted at the IDP families as they exit the camps and try to begin their lives anew. Last month IMHO provided support in the amount of $17,000 for two mental health projects in the Jaffna area being implemented by the Tellipalai Mental Health Society, which works hand-in-hand with the Jaffna Teaching Hospital. The first project is to maintain 11 members of an existing multi-disciplinary team working closely with the government mental health services in the Jaffna District, and the second is to support a mobile mental health team who are serving IDPs/resettled

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projects in the Jaffna area being implemented by the Tellipalai Mental Health Society, which works hand-in-hand with the Jaffna Teaching Hospital. The first project is to maintain 11 members of an existing multi-disciplinary team working closely with the government mental health services in the Jaffna District, and the second is to support a mobile mental health team who are serving IDPs/resettled IDPs specifically. These teams will provide general counseling, child counseling, family counseling and support, alcohol counseling, psycho-social interventions, vocational training, play activities, relaxation therapy, and more. Additionally, IMHO also allocated $10,000 to support an in-patient psychiatric unit at the Negombo Hospital in Negombo, Sri Lanka.

West Sumatra Earthquake Victims get Boost from IMHO through Relief International

Continuing to respond to the massive humanitarian crisis facing Southeast Asia following a series of natural disasters this fall, IMHO directed an additional $5,000 in funds to assist in the medical relief effort in West Sumatra, Indonesia. The funds were given to Relief International, a well-established US-based relief & development nonprofit organization, and have surely gone a long way in providing much-needed medicines and other supplies to survivors trying to piece their lives back together.

Resettled IDPs in Sri Lanka Now Facing Incredible Challenges

Large numbers of IDPs in Northern Sri Lanka have been released in the past several weeks. The vast majority have been resettled in their districts of origin and are now staying with "host families", but many more that have been released have not yet returned to their own districts and thus remain in displacement. Most of those who have been resettled are now residing in Jaffna, although significant populations have been relocated to Mullaitivu, Kilinochchi, Vavuniya, Mannar, Trincomalee, and other locations, in that order. As of November 12, 2009, a census revealed there were 134,568 IDPs remaining in camps, all of whom are expected to be fully released within the coming months (by end of January 2010). Amongst the remaining are IDPs are an estimated 1,600 pregnant mothers and approximately 29,000 children who are 5 years or younger. There has been great progress in improving the overall physical health of the remaining IDPs and a very significant reduction in the incidence of disease, including typhoid, diarrhea, chicken pox, dysentery, and Hepatitis A. At present, only UN agencies are being allowed access to the Vanni. As part of their resettlement package being coordinated by the UN and government officials, IDP families have been allocated household items, such as cooking utensils, agricultural tools, corrugated sheets, and dry rations to last for 6 months. It has been reported that each family should also be receiving Rs. 25,000 ($220), free electricity for 6 months, seeds for planting crops, and subsidized agricultural plots. However, there are major logistical concerns in actually delivering these services to the people, and it is unclear how effective they will be. Ambulances and health teams are supposed to be deployed to the areas where IDPs are being resettled, as well. The resettlement process presents many difficulties and impediments, and it is sure to be a long, complex, and oftentimes chaotic process. "Host families" face serious burdens, including a severe economic strain, in hosting IDPs. Livelihoods have not yet been re-established, and local economies are far from returning to normalcy. These are extraordinary circumstances under which countless people now find themselves living throughout the Northeast. Infrastructure must be redeveloped and made operational again, with so much of it destroyed or damaged throughout years of war. In addition, many who have been released have not yet been able to return to their actual communities or homes, many of which have been destroyed anyway. With significant areas of land still heavily mined, it may not also be safe for families to return to all areas. There are surely no quick solutions or easy answers to addressing all of these concerns and more, but IMHO remains committed to serving the people during this time of great need through a comprehensive and thoughtful approach to relief and development.

Amputees Remain a Top Priority

Mannar General Hospital, to which IMHO had earlier provided support for amputee rehabilitation through Sivan Arul Illam Trust, is happy to report that a visiting team of doctors and technicians from the UK & Colombo successfully fitted over a hundred amputees with artificial limbs on patients based at Mannar Hospital & at Cheddikulam IDP camps. Two wards at the hospital, donated by the Red Cross, were used as workshops and for clinic facilities. A mobile prosthetic workshop was also rented to treat the patients at the IDP camp. The team received immense support from the surgeon, nurses and chaplain's staff based at the hospital. Prostheses were shipped from the UK, and limbs were fabricated following measurements, and then fitted within days. The patients were immensely grateful! There are many more new amputees & musculo-skeletally injured (estimated as 4,200 by Ministry of Health) from the recent war remaining in the IDP camps as of early November 2009, who are waiting to be treated. There is also a desperate need for mobility aids such as wheelchairs and crutches. Many of these amputees have lost their families, homes and jobs. To achieve satisfactory long-term rehabilitation of these patients, financial assistance and ongoing input from skilled and dedicated clinicians are needed. At present there is an acute shortage of technicians and therapists in the hospital needed to manage these patients. There are many young disabled patients with multiple limb amputations who have limited prospects of walking and resuming physical activities. These patients need suitable mobility aids such as powered wheelchairs to mobilize independently. They also need assistance with housing and employment, as they have no prospects of returning to previous means of earning a livelihood. Sivan Arul Illam Trust is exploring options to provide suitable housing and employment training for this group of patients, including vocations such as sewing, computing, office-based work and other local business job opportunities. However, financial support of this endeavor is greatly needed, and IMHO is appealing for donors to come forward to help meet this request. It is the hope of the Mannar General Hospital staff that the facility will ultimately have a well-staffed, fully-equipped, and comprehensive regional rehabilitation facility. This would enable satisfactory management of both amputees and spinal cord injured patients of all ages. In total, IMHO has committed $38,350 towards rehabilitation efforts for amputees, including $13,350 to Sivan Arul Illam Trust and $25,000 to Survivors Associated.

IMHO intends to do much more with this vulnerable group, as they face many challenges, and there are so many in need. We are actively seeking donors and other partners to assist in this important effort.

2009 IMHO Annual Report Available Online

We are proud to share with you our achievements this year in our 2009 IMHO Annual Report, which you can now access online here: http://www.theimho.org/publications/newsletters/226-2009-annual-report

We are proud to share with you our achievements this year in our 2009 IMHO Annual Report, which you can now access online here: http://www.theimho.org/publications/newsletters/226-2009-annual-report

Upcoming IMHO Events

***Michigan Dinner & Presentation***

WHEN: Saturday, December 5th, 2009 at 7:00pm WHERE: Ruchi Indian Cuisine, 29555 Northwestern Hwy, Southfield, Michigan, 48034 WHAT: 7:00-7:45pm Presentation on IMHO Efforts 7:45-9:00pm Question & Answer Session and Buffet Dinner Cost is $11 per person for dinner buffet. Children are welcome; ages 3-8 are half price. Please RSVP to Bala at bala.anushia@gmail.com or 248.538.4369.

***2nd Annual IMHO Ohio Golf Tournament*** WHEN: Monday, May 17th, 2010 at 12:30pm WHERE: New Albany Country Club, 1 Club Lane, New Albany, OH, 43054 WHAT: 18-hole scramble at the Jack Nicklaus Championship Golf Course HOW MUCH: $300/player or $1,000/team of 4 Please register yourself or your team early to ensure your spot in the tournament. You will have the chance to win a car at the hole-in-one hole sponsored by Liberty--Dodge, Chrysler, Jeep. For more information or to view the event flyer, please visit our website: http://www.theimho.org/events/upcoming-events/details/27-ohio-2nd-golf-tourney

Past IMHO Events

***Arizona & Indiana IMHO Events***

IMHO held two fundraising & awareness-raising events on Saturday, November 21st in Phoenix, Arizona and Carmel, Indiana. A nice buffet dinner, followed by an IMHO presentation and Question & Answer session by an IMHO representative, took place at a private residence in Phoenix. About 20 persons attended and learned about IMHO, its global activities, and its attention to the needs of the resettled (or soon to be resettled) IDPs in Sri Lanka. A second event was held in Carmel, Indiana at the Bayhill Club House. Organized by local supporters of IMHO, the event drew in a number of families and collected much needed funds for meeting the needs of the IDPs in Sri Lanka. We are very grateful to all who helped organize these events and bring IMHO to the attention of those in these new areas. If you or anyone you know is interested in starting an IMHO chapter or hosting an IMHO event, please contact the IMHO Programs Coordinator at coordinator@theimho.org to discuss specifics. Through the support of our volunteers we can continue to share our work with others and build the organization, so that we may better serve those in need globally.

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During this crucial time in Sri Lanka and around the world, as we face monumental challenges in providing better access to quality medical and health care for those most at-risk populations, we need YOUR HELP now more than ever. With just $15/month you can meet the nutritional needs of 1 IDP (internal refugee). Please consider making a donation to IMHO today. You can donate online via PayPal as a one-time or recurring donation (the amount & frequency of which are up to you). You can also donate via mail by sending a check made out to "IMHO" to the

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